What isPeriodontitis?

Untreated gingivitis can advance to periodontitis. This causes gums to separate from the teeth, forming pockets that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.

Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include the following:

Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.

Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Are You at Risk?

Your risk for periodontal disease may increase depending on:

Your age

Gender

Bleeding gums

Tobacco use

Family history of gum disease

To find out if you may be at risk, take the American Academy of Periodontology’s risk assessment here. The assessment will let you know if you are at low, moderate, or high risk for periodontal disease. Or schedule an appointment with our office and we will be happy to evaluate you and discuss your results with you.

Risk Factors, Symptoms & Prevention

The main cause of periodontal (gum) disease is plaque, but other factors affect the health of your gums.

Periodontal disease, also known as gum disease, is caused when bacteria in plaque (a sticky, colorless film that forms in the mouth) builds up between the gums and teeth. When the bacteria begin to grow, the gums surrounding the tooth can become inflamed.

If left untreated, this inflammation can cause the gums and supporting bone structure to deteriorate. This can lead to gum recession or even tooth loss. In addition, research has shown that gum disease may be associated with other diseases, such as diabetes and heart disease.

Luckily, periodontal disease can be preventable. Adding these habits to your daily routine can help.

Brush your teeth. Brushing after meals helps remove food debris and plaque trapped between your teeth and gums. Don’t forget to include your tongue, bacteria loves to hide there.
Floss. Flossing at least once a day helps remove food particles and plaque between teeth and along the gum line that your toothbrush can’t quite reach.

Swish with mouthwash. Using a mouthwash can help reduce plaque and can remove remaining food particles that brushing and flossing missed.

Know your risk. Age, smoking, diet and genetics can all increase your risk for periodontal disease. If you are at increased risk, be sure to talk with your dental professional.

See a periodontist. Get an annual comprehensive periodontal evaluation (CPE) from a dental professional. A CPE looks at your teeth, plaque level, gums, bite, bone structure and other risk factors for periodontal disease. Identifying symptoms of gum disease early is key to protecting your teeth and gums.

Studies indicate that older people have the highest rates of periodontal disease. Data from the Centers for Disease Control and Prevention indicates that over 70% of Americans 65 and older have periodontitis.

Tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Research has indicated that some people may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early intervention treatment may help them keep their teeth for a lifetime.

Stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. Stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

A diet low in important nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums. In addition, research has shown that obesity may increase the risk of periodontal disease.

Periodontal Disease and Treating It

Miracle cures, or quick fixes, have been around for centuries; certain foods, ointments, or potions have claimed to cure everything from hair loss to cancer. Marketed as quick, easy, and painless, these miracle cures often are not backed by science or approved by the Food and Drug Administration (FDA), which means that they may do more harm than good. Similar quick fixes that claim to treat periodontal disease are no different. Though elements of these quick and easy periodontal “cures” may be FDA approved, there may be little or no scientific proof that they are effective in the prevention and treatment of periodontal diseases. In fact, periodontal “miracle cures” may actually harm your oral health. Periodontal disease is a chronic inflammatory disease that affects the gums and bone supporting the teeth, and has been associated with the progression of other diseases such as cardiovascular disease and diabetes. If you opt for a treatment for periodontal disease that has not been backed by scientific evidence, it’s possible that the treatment won’t effectively treat (or could even worsen) your condition. Just because a treatment is deemed “new” or “innovative” doesn’t mean that it works properly or better than more traditional treatments. By choosing the quick fix route first, your oral health may remain in poor condition and you may require additional treatment.

Instead, a better idea is to schedule an appointment with a periodontist when you notice signs of periodontal disease (red, swollen or tender gums; bleeding while brushing or flossing; gums that are receding or pulling away from the teeth; loose or separating teeth). A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and their education and experience allow them to effectively treat periodontal disease using clinically proven treatments such as scaling and root planing, soft tissue grafts and regenerative procedures. A periodontist will evaluate your unique condition, and offer the treatment that is best for you; one that is supported by both science and experience. Your periodontist can also answer any questions that you may have about alternate treatment options.

Your oral health is invaluable. While quick fixes for periodontal disease may seem like a good option, it’s a better idea to research treatment options and discuss them with a periodontist first. The discussion has the possibility of saving you time and money in the long-run!

So you have periodontal disease, what next?

If you’ve recently been diagnosed with periodontal disease, you probably have some questions about your treatment. Be assured that periodontists believe that periodontal therapy should be achieved in the least invasive and most cost-effective way possible; this includes nonsurgical therapy.

Remember that the first step toward good oral health begins with proper oral hygiene. This includes brushing your teeth at least twice each day and flossing at least once each day. Good oral hygiene along with regular visits to a dental professional, such as a periodontist, can go a long way toward preventing certain forms of periodontal disease and reversing gingivitis, an early stage of periodontal disease.

If you have more significant disease, you may require an in-depth cleaning called scaling and root planing (SRP). SRP is a careful cleaning of the tooth root surfaces to remove plaque from pockets and to remove bacteria and toxins from the tooth root. Research has consistently shown that SRP reduces inflammation of the gums and reduces the amount of bacteria associated with periodontal disease. Due to these positive findings, SRP is usually the first mode of treatment recommended for most patients. In fact, many people do not require any further active treatment after SRP.

In some cases, systemic antibiotics (antibiotics that are taken by mouth) are prescribed at the time of SRP to help control bacteria levels. However, each time you take an antibiotic you increase your chance of developing drug resistant bacteria. Therefore, it is very important to take antibiotics only when necessary. Instead of a systemic antibiotic, your periodontist may prescribe a local delivery antimicrobial, medication that is delivered directly into periodontal pockets to control or kill periodontal bacteria. In general, local delivery antimicrobials do not lead to antibiotic resistance.
When tooth surfaces are not in harmony between the upper and lower teeth, an occlusal adjustment may be necessary. This is because teeth that do not properly fit together can affect the rate of progression of periodontal disease. During this procedure, your periodontist may take a mold of your teeth to determine the areas of concern, which will be adjusted. You may also need to wear an occlusal guard or night guard to be worn at certain times of the day to minimize the effects of teeth grinding.

Following adequate time to respond to your treatment, you will be asked to return to your periodontist to determine if further treatment is necessary. If you need further treatment, your periodontist, in collaboration with your general dentist will develop a treatment plan to help restore your smile to a state of health. If you don’t need further treatment, you’ll enter into a maintenance phase. These appointments are usually more thorough than traditional six-month cleanings and may occur more often, which will help protect the health of your teeth and gums.

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone can be destroyed, leading to pockets. Eventually, too much bone can be lost, leading to teeth falling out or needing to be extracted. To fix this, your periodontist may recommend a regenerative procedure that will reverse some of the damage by regenerating lost bone and tissue with the help of bone grafts. Tissue grafts, procedures that place gum tissue in places where it has receded (such as exposed tooth roots), may also be utilized in regeneration procedures.

Your Gums and Your Smile

A smile is one of the most universally recognizable expressions. Smiling can demonstrate a person’s happiness, confidence, attractiveness, sociability, and sincerity. However, the effects of gum disease or other oral tissue disorders cannot only be dangerous to your health and well-being, but can also have the potential to ruin your smile. Luckily, periodontists are the experts in treating the tissues around the teeth. They have the know-how to treat the effects of gum disease or other oral tissue disorders and help improve your smile. There are a variety of periodontal cosmetic procedures that can improve and enhance the overall artwork of your smile.

Missing Teeth

Gum disease is one of the leading causes of tooth loss in adults. In the past, the only options for disguising tooth loss were dentures and bridges. Nowadays, dental implants are a more natural looking option because implants look and feel just like real teeth. They also allow the patient to speak and eat with comfort and confidence. During this procedure, a dental implant is attached to the root and after a healing period, an artificial tooth is attached. The result is a permanent replacement tooth that blends right in with the rest. Root Coverage Gum recession as a result of gum disease causes the tooth root to become exposed, which can make teeth look long and can prematurely age a person. In fact, the phrase “long in the tooth”, used to describe the elderly, is derived from this very reason. A periodontist can fix this problem with a procedure called root coverage. During this procedure, tissue from the mouth’s palate, or other synthetic materials, are used to facilitate coverage of the exposed root. Gummy Smile Periodontists also have the ability to fix a “gummy smile” when a person’s teeth appear too short. The teeth may actually be the proper length, but they’re covered with too much gum tissue. Your periodontist can correct this by performing a procedure called crown lengthening. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. Think of it like pushing back the cuticles on a fingernail. The outcome is longer looking teeth and a winning smile. Your gums are an important part of your smile. They frame the teeth and play an integral role in the overall aesthetics of your everyday appearance. While taking care of them by brushing and flossing daily is the best way to maintain a healthy mouth, talk to your periodontist about the procedures available to maximize the potential of your smile.

Gum Disease

Other Linked Diseases

You may have seen stories in the news about the connection between periodontal disease and heart disease, stroke, and diabetes. However, those aren’t the only health conditions that are related to periodontal disease. Research has shown that having periodontal disease can put you at risk for a few surprising conditions including rheumatoid arthritis, certain cancers, and even kidney disease. Click on the item in the boxes below to learn more.

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Inflammation is the body’s instinctive reaction to fight off infection, guard against injury or shield against irritation. Acute cases of inflammation are easily identifiable, and are often characterized by swelling, redness, heat and pain around the affected area. While acute inflammation initially intends to heal the body, over time, if left untreated, it can lead to chronic inflammation. Chronic inflammation can lead to dysfunction or destruction of the infected tissues, and potentially more severe health complications.

Most people know that maintaining healthy teeth and gums is a necessary step in achieving overall wellbeing. In fact, now not only dentists encourage brushing and flossing, but many physicians also promote oral hygiene as a way to help keep the rest of the body healthy. Several research studies have suggested that gum disease may be associated with other health issues, including heart disease, stroke and diabetes. And with more and more research reinforcing the connection between periodontal and systemic health, scientists are beginning to understand why these connections exist. One theory points to chronic inflammation as the culprit.

Inflammation is the body’s natural response to harm, such as an injury or infection. For many years, dentists believed that gum disease developed as a result of a bacterial infection caused by the build-up of plaque between the teeth and under the gums. While plaque build-up is still a factor in the development and progression of gum disease, researchers now suspect that the more severe symptoms, namely swollen, bleeding gums; recession around the gum line, and loss of the bone that holds the teeth in place, may actually be caused by the chronic inflammatory response to the bacterial infection, rather than the bacteria itself.

Scientists hypothesize that the chronic inflammatory response mechanism may be the reason behind the periodontal-systemic health link. Many of the diseases associated with periodontal disease are also considered to be systemic inflammatory disorders, including cardiovascular disease, diabetes, rheumatoid arthritis, kidney disease and even certain forms of cancer, suggesting that chronic inflammation itself may be the basis for the connection. More research is needed to pinpoint the precise biological mechanisms responsible for the relationship between gum disease and other disease states. However, since previous findings have indicated that gum disease sufferers are at a higher risk for other diseases, it is critical to maintain periodontal health in an effort to achieve overall health. Dentists recommend daily oral care, including regular brushing and flossing, and routine visits to the dentist to avoid gum disease. If gum disease develops, consultation with a dental professional such as a periodontist can lead to effective treatment. A periodontist is a dentist with three years of additional specialized training in the prevention, diagnosis and treatment of gum disease. For more information on the role of inflammation in oral health, tips on how to prevent or treat gum disease, to find out if you are at risk, contact us for an appointment and a comprehensive periodontal evaluation.

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.

Research has suggested that the relationship between diabetes and periodontal disease goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.

Cardiovascular disease (CVD) is one of the leading killers of men and women each year. Research has shown that inflammation is a major risk factor for developing CVD, and that people with periodontal disease may have an increased risk for CVD. Though more research is needed to better understand the connection between periodontal disease and CVD, don’t be surprised if your periodontist asks you about your heart health or if your cardiologist or physician asks you about your periodontal health.

Gum disease and cardiovascular disease are both major public health issues that impact a large number of Americans every day. While these two diseases impact separate areas of the body, research indicates that periodontal disease and cardiovascular disease are connected; having one disease may actually increase your risk of developing the other.

Inflammation’s Role: Periodontal disease and cardiovascular disease are both considered chronic inflammatory conditions. Inflammation is the body’s instinctive reaction to fight off infection. Inflammation is initially good for your body because it helps in the healing process. However, chronic and prolonged inflammation can lead to severe health complications. Researchers believe that inflammation provides the basis for the connection between gum disease and heart disease1. And now, periodontists and those who treat cardiovascular disease are working together to provide the best care to patients.

The Perio-Cardio Connection In July 2009, a consensus paper was published in both the Journal of Periodontology and The American Journal of Cardiology. The paper was jointly developed by periodontists and cardiologists Periodontists are dentists with advanced training in the treatment and prevention of periodontal disease, and cardiologists are doctors who specialize in treating diseases of the heart. The paper summarizes the evidence that links periodontal disease and cardiovascular disease, and provides clinical recommendations for periodontists and cardiologists to use in managing their patients living with, or at risk for, either disease.

What does this Mean for You? You might be surprised when your periodontist now asks even more questions about your medical history, especially questions about your family history of heart disease and any behaviors that may affect your heart health such as smoking. Your cardiologist may start to ask you about your dental history and might even look in your mouth to evaluate your teeth and gums! These new recommendations are intended to help periodontists and cardiologists better manage your risk factors for future disease progression, and ensure your wellbeing. Hopefully by working together with your periodontist to ensure healthy teeth and gums, you will also ensure a healthy heart throughout your entire life.

Since several studies have suggested a link between periodontal disease and cardiovascular disease, it is more important than ever to take care of your teeth and gums! Brush your teeth twice each day, as well as floss once each day. It is also important to see your dental professional for routine check-ups. To learn more about gum disease, visit perio.org.

Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease.

Scientists believe that inflammation caused by periodontal disease may be responsible for the association.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Over 1.3 million Americans suffer from rheumatoid arthritis (RA), a chronic, inflammatory disease of the joints that can lead to long term joint damage. A study published in the Journal of Periodontology uncovered yet another potential side effect of RA; researchers discovered that patients with RA are eight times more likely to have periodontal disease than those without RA. However, the research indicates that poor oral hygiene alone did not account for the connection between RA and gum disease, which means that other factors play a role as well. Both RA and gum disease are systemic inflammatory disorders which may explain the connection between the two.

Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.

Men are especially at risk for developing certain cancers if they have periodontal disease. Research published in The Lancet Oncology found that men with a history of gum disease are 14 percent more likely to develop cancer than men with healthy gums. In fact, researchers discovered that men with periodontal disease are 49 percent more likely to develop kidney cancer, 54 percent more likely to develop pancreatic cancer, and 30 percent more likely to develop blood cancers.

A study published in the Journal of Periodontology suggests that toothless adults may be more likely to have chronic kidney disease than adults with all of their teeth. Untreated periodontal disease can lead to bone loss around teeth, which can then cause teeth to loosen and fall out. Periodontal disease is a leading cause of tooth loss in adults. In the study, the lack of teeth was found to be significantly associated with chronic kidney disease. The two diseases may be connected by chronic inflammation, as both are considered inflammatory conditions.

To help protect yourself from these health conditions, including periodontal disease, make sure to brush your teeth twice each day, floss at least once each day, and see a dental professional for cleanings twice each year. If periodontal disease develops, a consultation with a dentist or periodontist may lead to effective treatment. The key to a healthy body may start with a healthy mouth!

Peri-implant diseases are inflammatory conditions affecting the soft and hard gum tissues around dental implants. Similar to a natural tooth, bacteria can build up on the base of the implant, below the gum line. Over time, the bacteria irritate the gum tissue, causing it to become inflamed, damaging the tissue and if not caught early, causing the bone structure below the implant to deteriorate.

Peri-implant diseases are classified into two categories.

In peri-implant mucositis, gum inflammation is found only around the soft tissues of the dental implant, with no signs of bone loss. Generally peri-implant mucositis is a precursor to peri-implantitis. Evidence suggests that peri-implant mucositis may be successfully treated and is reversible if caught early.

In peri-implantitis, gum inflammation is found around the soft tissue and there is deterioration in the bone supporting the dental implant. Peri-implantitis usually requires surgical treatment.

Signs of peri-implant diseases are similar to symptoms of gum disease: red or tender gums around the implants, or bleeding when brushing. And just like your natural teeth, implants require regular tooth brushing and flossing and regular check-ups from a dental professional. Other risks factors for developing peri-implant disease include previous periodontal disease diagnosis, poor plaque control, smoking, and diabetes. It is essential to routinely monitor dental implants as part of a comprehensive periodontal evaluation.

The up side to dental implants is they function just like your natural tooth. The down side is, they are capable of becoming diseased just like a natural tooth. With a proper oral health routine, your dental implant can last a lifetime.

Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.

Osteoporosis is a condition that causes low or decreasing bone mass. Untreated osteoporosis can often lead to tooth loss, mainly because the disease diminishes the density of the bone supporting the teeth. Since both osteoporosis and periodontal disease have shared risk factors such as tobacco use and age, and because both can result in bone loss, an association between the two diseases has been difficult to prove. However, if you are at risk for or being treated for osteoporosis, it is still important to keep your oral health at its best. Be sure to brush your teeth at least twice every day, floss at least once every day, and see a dental professional, such as a periodontist, every six months.

You may have heard recent reports about bisphosphonate drugs and their potential effect on periodontal health. These reports can be alarming and even misleading, especially for those taking bisphosphonates. The information below explains what bisphosphonates are, how they are related to periodontal health, and how bisphosphonates may impact your periodontal treatment. Bisphosphonates, also known as bone-sparing drugs, are used to treat and prevent osteoporosis, and are also prescribed to patients diagnosed with certain bone cancers. Bisphosphonates can be administered in two ways: orally and intravenously (IV). Oral, or tablet, bisphosphonates (common names include Fosamax, Boniva, and Actonel) are usually prescribed for osteoporosis, while IV bisphosphonates (common names include Aredia and Zometa) are typically prescribed for patients with advanced bone cancers to help decrease pain and fractures. In rare instances, some people that have been treated with bisphosphonates, especially the intravenous form, develop a rare condition called osteonecrosis of the jaw (ONJ), which can cause severe, irreversible, and often debilitating damage to the jaw. ONJ can be worsened by invasive dental procedures such as tooth extractions or dental implants. People may not have symptoms in the early stages of ONJ, but pain can gradually develop as the condition progresses.

Symptoms of ONJ include:

Loose teeth

Numbness or a feeling of heaviness in the jaw

Pain, swelling, or infection of the gums or jaw

Gums that do not heal

Exposed bone

Currently, there is no treatment that definitely cures ONJ. However, antibiotics and anti-inflammatory drugs may help relieve some of the pain associated with ONJ. Most people diagnosed with ONJ will also need surgical treatment. If your physician prescribes a bisphosphonate, especially IV bisphosphonates, it is very important to tell your dental professional, because your dental treatment plan may be affected. There have been other risk factors associated with ONJ including age, gender, and other medical conditions, so it is important to share all health information with your dental professional. It is also important to maintain your oral health if you are taking bisphosphonates. Even though the risk of developing ONJ while taking a bisphosphonate remains very small, if you need periodontal surgery, your dental professional may recommend that you interrupt your bisphosphonate therapy prior to, during, and/or after your procedure. Be assured that both the medical and dental communities are studying ways to ensure the safest outcomes for patients taking bisphosphonates who require invasive dental procedures

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